Healthcare Provider Details

I. General information

NPI: 1699810143
Provider Name (Legal Business Name): PAUL SALVATORE TETRO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 UNIVERSITY BLVD E STE 35
SILVER SPRING MD
20903-2915
US

IV. Provider business mailing address

831 UNIVERSITY BLVD E STE 35
SILVER SPRING MD
20903-2915
US

V. Phone/Fax

Practice location:
  • Phone: 301-445-6900
  • Fax: 301-445-6592
Mailing address:
  • Phone: 301-445-6900
  • Fax: 301-445-6592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1915
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: